CONSTRUCTION ROAD CLOSURE APPLICATION

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1300-1599 INFORMATION SYSTEMS AND SERVICES\1490 Records Management - General\1490-09 Forms

Management\Development Services\ROAD CLOSURES\Word Format for Revisions\Construction Road Closure APPLICATION (Rev. 2013-11-20)

CONSTRUCTION ROAD CLOSURE APPLICATION

Date of Application: _____________________ Permit #: ____________________________ Company Name:

Business Licence #: Reason for Closure:

Work Start: Date: ___________________ Time:

(mm/dd/yr)

Work End: Date: ___________________ Time:

(mm/dd/yr)

Work Site/Closure Route: (Detailed written description is required including a site plan. See back for site plan requirements) Contact Name: Mailing Address: _____________________________________________Postal Code:_____________________ Phone: ________________________________ Fax: E-Mail:

* HAVE YOU ATTACHED THE FOLLOWING? *

(1) Permit Fee - $96.60 + GST ($4.83) = $101.43 ...

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(acct. #CPOPR694-05740102

(2) Advertising “Proof” & Dates ...

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(3) $2,000,000 Liability Insurance (with City named as

"additional insured") ...

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(4) Route Map ...

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Please return completed application form to:

Secretary, Development Services

City of Penticton, 2nd Floor

171 Main Street, Penticton, BC V2A 5A9 Phone: (250) 490-2501

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SITE PLAN

Please show the location of road and sidewalk closures with details regarding how pedestrian and vehicular traffic will be safely detoured and addressed. Show all sign, fence and barricade locations. Indicate how access will be maintained to adjacent properties and how services such as Fire,

Ambulance or Waste Collection will be maintained. Label all streets and provide a North arrow.

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ADVERTISING REQUIREMENTS

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A copy of the “proof” for all newspaper advertising for the works indicating dates, locations

and times of road closures, including confirmation dates from the vendor for ad run dates, is

to be submitted with the application.

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Provide a letter to affected residents and businesses advising them of the pending closure and

duration of the project.

Should permit not be issued, the applicant will be responsible for any costs incurred with respect to this advertising

INSURANCE REQUIREMENTS

Evidence of current liability insurance is required from an applicant proposing to use municipal streets, parks or facilities for construction works.

The minimum liability insurance requirements are as follows:

1. $2,000,000 comprehensive general liability policy with inclusive limits for bodily injury and property damage liability including coverage for workers.

2. Cross-liability clause;

3. City of Penticton is named as Additional Insured;

4. 30 days prior written notice of cancellation or material change; 5. Executed copy of Certificate of Insurance, 10 days prior to the event.

ADDITIONAL REQUIREMENTS

You may be required to obtain:

RENTAL OF PARKING METER HOODS (SPACES) Yes No

Note: The applicant/company should be advised that they are fully responsible to determine

their own additional insurance coverage they may require, if any; including Workers

Compensation which is necessary and advisable for their own protection and/or fulfill

their obligations in organizing the works including protection of the municipality.

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Attachment A

TERMS AND REGULATIONS FOR CONSTRUCTION ROAD CLOSURE

The applicant will:

Name & Phone #

1. Be responsible for advising all workers and will ensure that all workers adhere strictly to all regulations posted and/or attached hereto. Failure to adhere to said conditions, terms and regulations could result in this permit being revoked without further notice and without refund of any fees paid.

2. Comply with requirements of the “Traffic Control Manual for Work on Roadways’, published by the British Columbia Ministry of Transportation and Highways for regulation of vehicle and pedestrian traffic or use of roadways.

3. Applicant and companies utilizing this permit will undertake to be responsible for the due observance of all regulations from any body governing the area described as Work Site/Closure Route.

4. Exercise the greatest care in use of the area authorized under this permit and adjacent premises.

5. Be responsible for any damages incurred, said damages to be paid firstly by the applicant and/or their insurer.

6. Use only the area described as Work Site/Closure Route named in this Agreement.

7. Not to permit any use of/the permitted areas other than that stated as the reason for closure, or assign this permit to any other party for any reason.

8. Be responsible for leaving the area described as Work Site/Closure Route clean and be responsible for damages to said area by the permitted or their assigns. Failure to do so may result in an additional fee levied for maintenance.

9. If you do not plan to use this permit please call the Development Services Secretary at

(250) 490-2501 and cancel.

10. Pay all fees levied according to this agreement including but not limited to, costs associated to any breach of this agreement.

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WAIVER OF INDEMNITY CLAUSE

The applicant accepts and will use the premises, lands and equipment at their own risk and agrees that neither the City of Penticton herein after referred to as the Municipality nor their officers, employees, servants, agents, heirs, successors and assigned have made any warranties or representations respecting the suitability or condition of the premises. The Applicant further agrees that it will indemnify and save harmless the municipality and their officers, employees, servants, agents heirs, successors and assigns from and against any and all claims whatsoever, including all damages, liabilities, expenses, costs including legal or other fees incurred in respect of any such claim (s) or any actions (s) or proceedings (s) brought thereon arising directly or indirectly from or in connection with the granting of this Agreement and use of the Premises.

Prior to the execution of this Agreement the Applicant will obtain and maintain comprehensive general liability insurance including participants insurance, without limitation, coverage for the indemnity provided herein, on terms satisfactory to the Municipality. The Municipality is to be included as named insured. Such policy will be written on a comprehensive basis with inclusive limits of not less than $2,000,000 per occurrence including $2,000,000 for bodily injury and/or death to any one or more persons including voluntary medical payment and property damage or such higher limits as the Municipality may require from time to time. The policy will contain a clause providing that the insurer will give the Municipality thirty (30) days prior written notice in the event of cancellation or material change. The Applicant will provide the Municipality with evidence of such insurance coverage in the form of an executed copy of a Certificate of Insurance in a form satisfactory to the Municipality ten (10) days prior to the execution of said agreement.

It is the sole responsibility of the Applicant to determine what additional insurance coverage, if any, including but not limited to Workers Compensation, are necessary and advisable for its own protection and/or to fulfill its obligations under this contract. Any such additional insurance shall be maintained and provided at the sole expense of the Applicant.

The Applicant understands and agrees that this Agreement may be revoked or cancelled at any time with or without cause. The municipality will make every reasonable attempt to provide a minimum 48 hours notice of a cancellation to the Applicant.

The Applicant warrants and represents that if he/she executes this Application on behalf of a Group or Organization and the Applicant has sufficient power, authority and capacity to bind the Group or Organization with his/her signature.

The Applicant, in consideration of being granted permission to use the Premises agrees to be bound by the Terms and Regulations referred to above and if the Applicant represents a Group or Organization, the Applicant agrees to inform all responsible officials associated with the Group or Organization of the Terms and Regulations and Waiver of Indemnity Clause.

I have read the above and fully understand the Terms and Regulations and the Waiver of Indemnity Clauses and will comply with said document.

Signed and Witnessed this ________ Day of ____________________, 20_____

________________________________ _________________________________ Signature of Applicant Signature of Witness

__________________________________ Print Name

CONSTRUCTION ROAD CLOSURE APPLICATION